Kona Community Hospital

All Charges

Charge

Type

Setting

Price

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

$4.31

Service Code	NDC 60687040579
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$4.18
Rate for Payer: Cash Price	$2.80
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: MDX Hawaii PPO	$4.18

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

$4.31

Service Code	NDC 60687040583
Hospital Revenue Code	250
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$4.18
Rate for Payer: Cash Price	$2.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.09
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: Kaiser Permanente Commercial	$2.72
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: MDX Hawaii PPO	$4.18
Rate for Payer: UnitedHealthcare Medicaid	$2.59
Rate for Payer: University Health Alliance Commercial	$3.14

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

$12.19

Service Code	NDC 00487020101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$11.82
Rate for Payer: Cash Price	$7.92
Rate for Payer: Hawaii Western Management Group Commercial	$11.58
Rate for Payer: Health Management Network Commercial	$10.36
Rate for Payer: Kaiser Permanente Commercial	$7.68
Rate for Payer: Kaiser Permanente Medicaid	$6.22
Rate for Payer: MDX Hawaii PPO	$11.82
Rate for Payer: UnitedHealthcare Medicaid	$7.31
Rate for Payer: University Health Alliance Commercial	$8.89

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

$1.99

Service Code	NDC 00487980101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: MDX Hawaii PPO	$1.93

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

$9.72

Service Code	NDC 76204010025
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$9.43
Rate for Payer: Cash Price	$6.32
Rate for Payer: Hawaii Western Management Group Commercial	$9.23
Rate for Payer: Health Management Network Commercial	$8.26
Rate for Payer: Kaiser Permanente Commercial	$6.12
Rate for Payer: Kaiser Permanente Medicaid	$4.96
Rate for Payer: MDX Hawaii PPO	$9.43
Rate for Payer: UnitedHealthcare Medicaid	$5.83
Rate for Payer: University Health Alliance Commercial	$7.08

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

$9.72

Service Code	NDC 76204010025
Hospital Revenue Code	250
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$9.43
Rate for Payer: Cash Price	$6.32
Rate for Payer: Health Management Network Commercial	$8.26
Rate for Payer: MDX Hawaii PPO	$9.43

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

$1.99

Service Code	NDC 00487980101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: Kaiser Permanente Commercial	$1.25
Rate for Payer: Kaiser Permanente Medicaid	$1.01
Rate for Payer: MDX Hawaii PPO	$1.93
Rate for Payer: UnitedHealthcare Medicaid	$1.19
Rate for Payer: University Health Alliance Commercial	$1.45

IPRATROPIUM BROMIDE 17 MCG/ACTUATION INHAL HFAA

Facility

$1,288.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$657.04
Max. Negotiated Rate	$1,249.67
Rate for Payer: Cash Price	$837.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,223.90
Rate for Payer: Health Management Network Commercial	$1,095.07
Rate for Payer: Kaiser Permanente Commercial	$811.64
Rate for Payer: Kaiser Permanente Medicaid	$657.04
Rate for Payer: MDX Hawaii PPO	$1,249.67
Rate for Payer: UnitedHealthcare Medicaid	$772.99
Rate for Payer: University Health Alliance Commercial	$939.06

IPRATROPIUM BROMIDE 17 MCG/ACTUATION INHAL HFAA

Facility

$1,288.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,095.07
Max. Negotiated Rate	$1,249.67
Rate for Payer: Cash Price	$837.41
Rate for Payer: Health Management Network Commercial	$1,095.07
Rate for Payer: MDX Hawaii PPO	$1,249.67

I-Ring Pupil Expander 587001 [3643828]

Facility

$1,137.60

Hospital Charge Code	3643828
Hospital Revenue Code	272
Min. Negotiated Rate	$966.96
Max. Negotiated Rate	$1,103.47
Rate for Payer: Cash Price	$739.44
Rate for Payer: Health Management Network Commercial	$966.96
Rate for Payer: MDX Hawaii PPO	$1,103.47

I-Ring Pupil Expander 587001 [3643828]

Facility

$1,137.60

Hospital Charge Code	3643828
Hospital Revenue Code	272
Min. Negotiated Rate	$580.18
Max. Negotiated Rate	$1,103.47
Rate for Payer: Cash Price	$739.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.72
Rate for Payer: Health Management Network Commercial	$966.96
Rate for Payer: Kaiser Permanente Commercial	$716.69
Rate for Payer: Kaiser Permanente Medicaid	$580.18
Rate for Payer: MDX Hawaii PPO	$1,103.47
Rate for Payer: University Health Alliance Commercial	$829.20

IRINOTECAN 100 MG/5 ML IV SOLN

Facility

$108.96

Service Code	HCPCS J9206
Hospital Revenue Code	250
Min. Negotiated Rate	$92.62
Max. Negotiated Rate	$105.69
Rate for Payer: Cash Price	$70.82
Rate for Payer: Cash Price	$108.76
Rate for Payer: Health Management Network Commercial	$92.62
Rate for Payer: Health Management Network Commercial	$142.23
Rate for Payer: MDX Hawaii PPO	$105.69
Rate for Payer: MDX Hawaii PPO	$162.31

IRINOTECAN 100 MG/5 ML IV SOLN

Facility

$167.33

Service Code	HCPCS J9206
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$162.31
Rate for Payer: Cash Price	$108.76
Rate for Payer: Cash Price	$70.82
Rate for Payer: Cash Price	$70.82
Rate for Payer: Cash Price	$108.76
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$103.51
Rate for Payer: Hawaii Western Management Group Commercial	$158.96
Rate for Payer: Health Management Network Commercial	$92.62
Rate for Payer: Health Management Network Commercial	$142.23
Rate for Payer: Kaiser Permanente Commercial	$105.42
Rate for Payer: Kaiser Permanente Commercial	$68.64
Rate for Payer: Kaiser Permanente Medicaid	$55.57
Rate for Payer: Kaiser Permanente Medicaid	$85.34
Rate for Payer: MDX Hawaii PPO	$162.31
Rate for Payer: MDX Hawaii PPO	$105.69
Rate for Payer: UnitedHealthcare Medicaid	$65.38
Rate for Payer: UnitedHealthcare Medicaid	$100.40
Rate for Payer: University Health Alliance Commercial	$79.42
Rate for Payer: University Health Alliance Commercial	$121.97

IRINOTECAN 300 MG/15 ML IV SOLN

Facility

$476.02

Service Code	HCPCS J9206
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$461.74
Rate for Payer: Cash Price	$309.41
Rate for Payer: Cash Price	$317.93
Rate for Payer: Cash Price	$317.93
Rate for Payer: Cash Price	$309.41
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$452.22
Rate for Payer: Hawaii Western Management Group Commercial	$464.66
Rate for Payer: Health Management Network Commercial	$415.75
Rate for Payer: Health Management Network Commercial	$404.62
Rate for Payer: Kaiser Permanente Commercial	$299.89
Rate for Payer: Kaiser Permanente Commercial	$308.15
Rate for Payer: Kaiser Permanente Medicaid	$249.45
Rate for Payer: Kaiser Permanente Medicaid	$242.77
Rate for Payer: MDX Hawaii PPO	$461.74
Rate for Payer: MDX Hawaii PPO	$474.45
Rate for Payer: UnitedHealthcare Medicaid	$285.61
Rate for Payer: UnitedHealthcare Medicaid	$293.47
Rate for Payer: University Health Alliance Commercial	$346.97
Rate for Payer: University Health Alliance Commercial	$356.52

IRINOTECAN 300 MG/15 ML IV SOLN

Facility

$476.02

Service Code	HCPCS J9206
Hospital Revenue Code	250
Min. Negotiated Rate	$404.62
Max. Negotiated Rate	$461.74
Rate for Payer: Cash Price	$309.41
Rate for Payer: Cash Price	$317.93
Rate for Payer: Health Management Network Commercial	$415.75
Rate for Payer: Health Management Network Commercial	$404.62
Rate for Payer: MDX Hawaii PPO	$474.45
Rate for Payer: MDX Hawaii PPO	$461.74

IRINOTECAN 40 MG/2 ML IV SOLN

Facility

$89.09

Service Code	HCPCS J9206
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$86.42
Rate for Payer: Cash Price	$57.91
Rate for Payer: Cash Price	$50.08
Rate for Payer: Cash Price	$50.08
Rate for Payer: Cash Price	$58.66
Rate for Payer: Cash Price	$58.66
Rate for Payer: Cash Price	$57.91
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$84.64
Rate for Payer: Hawaii Western Management Group Commercial	$73.19
Rate for Payer: Hawaii Western Management Group Commercial	$85.74
Rate for Payer: Health Management Network Commercial	$75.73
Rate for Payer: Health Management Network Commercial	$65.48
Rate for Payer: Health Management Network Commercial	$76.71
Rate for Payer: Kaiser Permanente Commercial	$48.54
Rate for Payer: Kaiser Permanente Commercial	$56.13
Rate for Payer: Kaiser Permanente Commercial	$56.86
Rate for Payer: Kaiser Permanente Medicaid	$39.29
Rate for Payer: Kaiser Permanente Medicaid	$45.44
Rate for Payer: Kaiser Permanente Medicaid	$46.03
Rate for Payer: MDX Hawaii PPO	$87.54
Rate for Payer: MDX Hawaii PPO	$74.73
Rate for Payer: MDX Hawaii PPO	$86.42
Rate for Payer: UnitedHealthcare Medicaid	$46.22
Rate for Payer: UnitedHealthcare Medicaid	$54.15
Rate for Payer: UnitedHealthcare Medicaid	$53.45
Rate for Payer: University Health Alliance Commercial	$65.78
Rate for Payer: University Health Alliance Commercial	$56.15
Rate for Payer: University Health Alliance Commercial	$64.94

IRINOTECAN 40 MG/2 ML IV SOLN

Facility

$90.25

Service Code	HCPCS J9206
Hospital Revenue Code	250
Min. Negotiated Rate	$76.71
Max. Negotiated Rate	$87.54
Rate for Payer: Cash Price	$58.66
Rate for Payer: Cash Price	$50.08
Rate for Payer: Cash Price	$57.91
Rate for Payer: Health Management Network Commercial	$65.48
Rate for Payer: Health Management Network Commercial	$75.73
Rate for Payer: Health Management Network Commercial	$76.71
Rate for Payer: MDX Hawaii PPO	$74.73
Rate for Payer: MDX Hawaii PPO	$87.54
Rate for Payer: MDX Hawaii PPO	$86.42

IRON BINDING CAPACITY

Professional

Both

$17.00

Service Code	HCPCS 83550
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$14.45
Rate for Payer: AlohaCare Medicaid	$12.08
Rate for Payer: AlohaCare Medicare	$8.74
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.61
Rate for Payer: Hawaii Medical Service Association Medicare	$8.74
Rate for Payer: Hawaii Western Management Group Commercial	$12.08
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.49
Rate for Payer: Kaiser Permanente Medicaid	$10.49
Rate for Payer: Kaiser Permanente Medicare	$10.49
Rate for Payer: Ohana Health Plan Medicaid	$12.08
Rate for Payer: Ohana Health Plan Medicare	$8.74
Rate for Payer: UnitedHealthcare Medicaid	$12.08
Rate for Payer: UnitedHealthcare Medicare	$8.74

IRON SUCROSE 100 MG/5 ML IRON IV SOLN

Facility

$324.07

Service Code	HCPCS J1756
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$314.35
Rate for Payer: Cash Price	$210.65
Rate for Payer: Cash Price	$210.65
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$307.87
Rate for Payer: Health Management Network Commercial	$275.46
Rate for Payer: Kaiser Permanente Commercial	$204.16
Rate for Payer: Kaiser Permanente Medicaid	$165.28
Rate for Payer: MDX Hawaii PPO	$314.35
Rate for Payer: UnitedHealthcare Medicaid	$194.44
Rate for Payer: University Health Alliance Commercial	$236.21

IRON SUCROSE 100 MG/5 ML IRON IV SOLN

Facility

$324.07

Service Code	HCPCS J1756
Hospital Revenue Code	250
Min. Negotiated Rate	$275.46
Max. Negotiated Rate	$314.35
Rate for Payer: Cash Price	$210.65
Rate for Payer: Health Management Network Commercial	$275.46
Rate for Payer: MDX Hawaii PPO	$314.35

IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST

Professional

Both

$83.00

Service Code	HCPCS 96523
Min. Negotiated Rate	$16.97
Max. Negotiated Rate	$70.55
Rate for Payer: AlohaCare Medicaid	$16.97
Rate for Payer: AlohaCare Medicare	$29.25
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Devoted Health Medicare	$32.17
Rate for Payer: Hawaii Medical Service Association Medicare	$29.25
Rate for Payer: Hawaii Western Management Group Commercial	$26.86
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$35.10
Rate for Payer: Kaiser Permanente Medicare	$35.10
Rate for Payer: Ohana Health Plan Medicaid	$16.97
Rate for Payer: Ohana Health Plan Medicare	$29.25
Rate for Payer: UnitedHealthcare Medicaid	$16.97
Rate for Payer: UnitedHealthcare Medicare	$29.25

IRRIGATION SODIUM CHLORIDE 500CC [2701102]

Facility

$9.44

Hospital Charge Code	2701102
Hospital Revenue Code	272
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$9.16
Rate for Payer: Cash Price	$6.14
Rate for Payer: Health Management Network Commercial	$8.02
Rate for Payer: MDX Hawaii PPO	$9.16

IRRIGATION SODIUM CHLORIDE 500CC [2701102]

Facility

$9.44

Hospital Charge Code	2701102
Hospital Revenue Code	272
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$9.16
Rate for Payer: Cash Price	$6.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.97
Rate for Payer: Health Management Network Commercial	$8.02
Rate for Payer: Kaiser Permanente Commercial	$5.95
Rate for Payer: Kaiser Permanente Medicaid	$4.81
Rate for Payer: MDX Hawaii PPO	$9.16
Rate for Payer: University Health Alliance Commercial	$6.88

IRRIGATION STERILE WATER 1000CC [2701096]

Facility

$18.02

Hospital Charge Code	2701096
Hospital Revenue Code	272
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$17.48
Rate for Payer: Cash Price	$11.71
Rate for Payer: Health Management Network Commercial	$15.32
Rate for Payer: MDX Hawaii PPO	$17.48

IRRIGATION STERILE WATER 1000CC [2701096]

Facility

$18.02

Hospital Charge Code	2701096
Hospital Revenue Code	272
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$17.48
Rate for Payer: Cash Price	$11.71
Rate for Payer: Hawaii Western Management Group Commercial	$17.12
Rate for Payer: Health Management Network Commercial	$15.32
Rate for Payer: Kaiser Permanente Commercial	$11.35
Rate for Payer: Kaiser Permanente Medicaid	$9.19
Rate for Payer: MDX Hawaii PPO	$17.48
Rate for Payer: University Health Alliance Commercial	$13.13

Know your out-of-pocket cost for care.

All Charges